Provider Demographics
NPI:1063746501
Name:HEAVIRLAND, ALISON ADELE (NCTMB)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:ADELE
Last Name:HEAVIRLAND
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2754
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-2754
Mailing Address - Country:US
Mailing Address - Phone:907-362-2321
Mailing Address - Fax:
Practice Address - Street 1:13745 BEACH DR.
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664-2754
Practice Address - Country:US
Practice Address - Phone:907-362-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist